Patients aged <60 y with favorable risk |
• HiDAC 3 g/m2 over 3 h every 12 h on days 1, 3, 5 or 1, 2, 3 × 3‐4 cycles, or
• Cytarabine 1000 mg/m2 every 12 h on days 1‐4 + daunorubicin 60 mg/m2 on day 1 (first cycle) or days 1‐2 (second cycle) + gemtuzumab ozogamicin 3 mg/m2 on day 1 × 2 cycles (CD33‐positive) |
Patients aged <60 y with intermediate risk |
Matched sibling or alternative donor HCT, or
HiDAC 1.5‐3 g/m2 over 3 h every 12 h on days 1, 3, 5 or 1, 2, 3 × 3‐4 cycles, or
HiDAC 1.5‐3 g/m2 over 3 h every 12 h on days 1, 3, 5 or 1, 2, 3 with oral midostaurin 50 mg every 12 h on days 8‐21 (FLT3‐mutated AML), or
Cytarabine 1000 mg/m2 every 12 h on days 1‐4 + daunorubicin 60 mg/m2 on day 1 (first cycle) or days 1‐2 (second cycle) + gemtuzumab ozogamicin 3 mg/m2 on day 1 × 2 cycles (CD33‐positive)
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Patients aged <60 y with treatment‐related disease other than CBF and/or with poor risk |
Matched sibling or alternative donor HCT, or
HiDAC 1.5‐3 g/m2 every 12 h on days 1, 3, 5 or 1, 2, 3 × 3‐4 cycles, or
HiDAC 1.5‐3 g/m2 every 12 h on days 1, 3, 5 or 1, 2, 3 with oral midostaurin 50 mg every 12 h on days 8‐21 (FLT3‐mutated AML), or
Dual‐drug liposomal encapsulation cytarabine 65 mg/m2 and daunorubicin 29 mg/m2 on days 1 and 3 (cytotoxic therapy‐related AML or patients with antecedent MDS/CMML or cytogenetic changes consistent with MDS)
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Patients aged ≥60 y with CR after intensive induction therapy |
Reduced‐intensity HCT, or
Standard‐dose cytarabine with or without an anthracycline (idarubicin or daunorubicin) or intermediate‐dose cytarabine for 4‐6 doses for 1 or 2 cycles (if good performance status, normal renal function, better‐risk or normal karyotype and favorable molecular markers), or
Dual‐drug liposomal encapsulation cytarabine 65 mg/m2 and daunorubicin 29 mg/m2 on days 1 and 3 (cytotoxic therapy‐related AML or patients with antecedent MDS/CMML or cytogenetic changes consistent with MDS), or
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Cytarabine 1000 mg/m2 every 12 h on days 1‐4 + daunorubicin
60 mg/m2 on day 1 (first cycle) or days 1‐2 (second cycle) + gemtuzumab ozogamicin 3 mg/m2 on day 1 × 2 cycles (CD33‐positive), or
Maintenance therapy with hypomethylating agents (5‐azacitidine, decitabine) every 4‐6 weeks until progression (if patient received hypomethylating agents during induction)
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Patients aged ≥60 y with CR after lower intensity therapy |
Reduced‐intensity HCT
Hypomethylating agents (5‐azacitidine or decitabine) every 4‐6 weeks until progression
Gemtuzumab ozogamicin 2 mg/m2 on day 1 every 4 weeks up to 8 continuation courses (CD33‐positive)
Continue enasidenib (IDH2‐mutated AML) or ivosidenib (IDH1‐mutated AML) until progression
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